Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also hooked on fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
After five days, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she relapsed. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her stop using only led to greater shame and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The baby was taken to the NICU. When Stephanie at last met her, she was attached to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.
She stepped out of the hospital still in detox, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still was concerned that child services would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could arrive and remove her child.
For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about getting by. Drugs came first; trust came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to love herself, much less anyone else.
Daily, staff from the facility transported her to a treatment center, provided orally. Over time, she was embracing sobriety.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a pompom on her head, resting on the floor with the door behind her. She is lean. Her posture is humble so you miss her features. She is holding Izzie up on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I would become a mother.”
Methods to address babies with exposure have existed for decades.
The evaluation method was created in 1975|
